特立帕肽可改善胸12椎体上终板上方椎体的体积骨密度和精细骨结构，并减少成人脊柱畸形手术后的骨质疏松性椎体骨折（PJK）。
Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity.
作者信息
Yagi M, Ohne H, Konomi T, Fujiyoshi K, Kaneko S, Komiyama T, Takemitsu M, Yato Y, Machida M, Asazuma T
机构信息
Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1, Musahsimurayama City Gakuen, Tokyo, Japan.
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
出版信息
Osteoporos Int. 2016 Dec;27(12):3495-3502. doi: 10.1007/s00198-016-3676-6. Epub 2016 Jun 24.
UNLABELLED
We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK.
INTRODUCTION
Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity. This study sought to determine whether teriparatide (TP) is an effective prophylactic against PJK type 2 (vertebral fracture) in surgically treated patients with adult spinal deformity (ASD).
METHODS
Forty-three patients who started TP therapy immediately after surgery and 33 patients who did not receive TP were enrolled in this prospective case series. These patients were female, over 50, surgically treated for ASD, and followed for at least 2 years. Preoperative and postoperative standing whole-spine X-rays and dual-energy X-ray absorptiometry scans, and multidetector CT images obtained before and 6 months after surgery were used to analyze the bone strength in the vertebra above the upper-instrumented vertebra (UIV+1).
RESULTS
Mean age was 67.9 years. After 6 months of treatment, mean hip-bone mineral density (BMD) increased from 0.721 to 0.771 g/cm in the TP group and decreased from 0.759 to 0.729 g/cm in the control group. This percent BMD change between groups was significant (p < 0.05). The volumetric BMD (326 to 366 mg/cm) and bone mineral content (BMC) (553 to 622 mg) at UIV+1 were also significantly increased in TP group. The bone volume/tissue volume ratio increased from 46 to 54 % in the TP group, and the trabecular bone thickness and number increased by 14 and 5 %, respectively. At the 2-year follow-up, the PJK type 2 incidence was significantly lower in the TP group (4.6 %) than in the control group (15.2 %; p = .02).
CONCLUSIONS
Prophylactic TP treatment improved the volumetric BMD and fine bone structure at UIV+1 and reduced the PJK-type 2 incidence.
未标注
我们进行了一项前瞻性比较研究，以探讨特立帕肽治疗对预防成人脊柱畸形重建手术后椎体骨折型近端交界性后凸（PJK）的效果。预防性使用特立帕肽可改善上位内固定椎体上方椎体的体积骨密度和精细骨结构，并降低椎体骨折型PJK的发生率。
引言
近端交界性后凸（PJK）是脊柱畸形矫正手术后的一种并发症。本研究旨在确定特立帕肽（TP）在接受手术治疗的成人脊柱畸形（ASD）患者中是否是预防2型PJK（椎体骨折）的有效药物。
方法
本前瞻性病例系列纳入了43例术后立即开始TP治疗的患者和33例未接受TP治疗的患者。这些患者均为50岁以上女性，接受了ASD手术治疗，并随访至少2年。术前和术后的站立位全脊柱X线片、双能X线吸收法扫描以及手术前和术后6个月获得的多排CT图像用于分析上位内固定椎体（UIV+1）上方椎体的骨强度。
结果
平均年龄为67.9岁。治疗6个月后，TP组的平均髋部骨密度（BMD）从0.721 g/cm增加至0.771 g/cm，而对照组从0.759 g/cm降至0.729 g/cm。两组之间的BMD变化百分比具有显著性差异（p<0.05）。TP组UIV+1处的体积骨密度（从326 mg/cm增加至366 mg/cm）和骨矿物质含量（BMC）（从553 mg增加至622 mg）也显著增加。TP组的骨体积/组织体积比从46%增加至54%，小梁骨厚度和数量分别增加了14%和5%。在2年随访时,TP组2型PJK的发生率显著低于对照组（4.6% 比15.2%；p = 0.02）。
结论
预防性TP治疗改善了UIV+1处的体积骨密度和精细骨结构，并降低了2型PJK的发生率。
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